Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization

Abstract

Purpose To determine pregnancy rates after conventional and partial uterine fibroid embolization (UFE). Materials and Methods The study received institutional review board approval and all patients gave written informed consent. A retrospective analysis of data collected prospectively was performed between June 2004 and June 2014 in a cohort of 359 women (mean age, 35.9 years ± 4.8) with uterine fibroids and/or adenomyosis who were unable to conceive. The median follow-up period was 69 months (range, 6-126 months). Under local anesthesia, both uterine arteries were embolized. In 160 patients, partial embolization was intentionally performed to preserve fertility, which may be decreased after conventional UFE. In partial UFE, only the small arterial vessels to the fibroids were embolized, leaving the large vessels of the fibroids patent. The Kaplan-Meier method and Cox regression were used for the statistical analysis. Results During follow-up, 149 women became pregnant, 131 women had live births, and 16 women had several pregnancies, resulting in a total of 150 live newborns. It was the first pregnancy for 85.5% (112 of 131) of women. Spontaneous pregnancy rates at 1 year and 2 years after UFE were 29.5% and 40.1%, respectively. The probability of successful pregnancy with live birth at 1 year and 2 years was 24.4% and 36.7%, respectively. Clinical success for fibroid-related symptoms was 78.6% (282 of 359). A dominant submucosal fibroid and ischemia greater than or equal to 90% had greater likelihood of spontaneous pregnancy. Complication rates in patients treated with partial UFE (14.6%) were not greater than rates in patients treated with conventional UFE (23.1%, P = .04). Conclusion Conventional and partial UFE may be safe and effective outpatient procedures for women with uterine fibroids who want to conceive. RSNA, 2017.

Long-term outcome and pre-interventional predictors for late intervention after uterine fibroid embolization

“…Last, we could not find preinterventional demographic characteristics as risk factors for late reintervention, which is in contrast to Tropeano et al [32] and Scheurig-Muenkler et al [33] who identified the risk of treatment failure to be twice as high for patients < 40 years of age compared to patients above the age of 45 years. Although several studies reported term pregnancies after UFE [9,[10][11][12]14,[34][35][36], early guidelines considered a potential patient's childbearing wish as a contraindication for UFE [32]. In the present report, nearly 40% of patients (n=9/23) who expressed their wish for a pregnancy after UFE, had a term pregnancy; another 2 patients had ectopic pregnancy and the remaining 12 patients did not become pregnant.…”

“…Mid-and long-term studies evaluating therapy effectiveness after UFE suggest freedom from treatment failure between 70%-90%, based on follow-up times between 1 and 10 years [2,3,[5][6][7][8][9]; however, follow-up data longer than 10 years after UFE are scarce as well as preinterventional factors predicting higher risk for treatment failure and late conversion to surgery. Finally, data on fertility after UFE are somewhat contradictory [10][11][12][13][14], and most of the international guidelines consider UFE as a secondary treatment in selected patients with fibroidrelated infertility [15][16][17][18].…”

Impact of uterine contractility on quality of life of women undergoing uterine fibroid embolization

“…Most women with uterine fibroids report a negative impact of symptoms, such as abnormal uterine bleeding and pelvic pain, on their quality of life (Spies et al 2002;Williams et al 2006;Harding et al 2008;Brito et al 2014). UFE has been reported as a less morbid alternative in women who wish to preserve their uterus when hysterectomy and myomectomy are contraindicated, when fibroids are refractory to myomectomy, or when there is a high risk of conversion to hysterectomy (Spies et al 2002;Pisco et al 2017;Mohan et al 2013;Fornazari et al 2019). In this setting, UFS-QOL is a validated tool for measuring patient-reported symptoms and documenting clinical outcomes from surgical and interventional procedures (Spies et al 2002;Williams et al 2006;Harding et al 2008), with good internal consistency, discriminant validity, construct validity, structural validity, test-retest similarity, and responsiveness, including in its Portuguese version (Oliveira Brito et al 2017;Silva et al 2016).…”

“…Moreover, the impact of fibroids in infertility is not yet clear. Most patients who are willing to become pregnant choose to undergo myomectomy, yet studies have demonstrated successful pregnancies post-UFE (Pisco et al 2017;Mohan et al 2013). One of the hypotheses for the association between fibroids and infertility is alteration of uterine contractility, according to Kunz's classification (Kunz et al 1996).…”

Current and Future Surgical and Interventional Management Options for Adenomyosis

“…This may not accurately depict the true miscarriage rate, as only seven women in this study had pure adenomyosis. 35 As there is limited obstetrical literature following UAE for adenomyosis, the rates of abnormal placentation are unknown.…”